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Kenai rape exams cut back due to nursing shortage

A nursing shortage that led Providence Alaska Medical Center to temporarily stop doing overnight forensic exams of sexual assault victims also is afflicting the Kenai Peninsula.

Central Peninsula Hospital in Soldotna is down to just three specially trained forensic nurses, and they not only conduct exams of reported rape victims but also do so in cases of child abuse and neglect, elder abuse, and domestic violence.

On Monday, the hospital's Clinical Forensic Services stopped offering the exams between 8 p.m. and 8 a.m. until more nurses are trained and come on board, said Colleen James, the program's coordinator, who splits her time between Homer and Soldotna.

"In order to keep our nursing staff, we really needed to come up with a model that was going to allow people to get rest," James said.

In Homer, James and one additional nurse serve South Peninsula Hospital. James started the state's first sexual assault nurse examiner program there in 1993. The Homer program originally was staffed around the clock with on-call nurses, but around 2001 or so cut back. Nurses from Homer and Soldotna back each other up, James said.

In Soldotna, a forensic nurse will still try to respond in the middle of the night during crisis situations involving a victim who had just been raped or battered, if any are available, James said.

Many child abuse cases arise from mistreatment going back weeks, months or even years, she said. She estimated that of the 179 patients seen by the forensic nurses in Soldotna last year, about a dozen were suffering from assaults or abuse that had just happened.

Jennifer Enersen, a Soldotna nurse who has been doing forensic exams the past 1½ years and also works as a critical care floor nurse, flagged the Kenai problem over the weekend in an email.

She wrote that she had done four child abuse exams in 16 hours.

"I have been on call since Tuesday evening at 7 p.m. It is now Saturday morning at 6:15 a.m. Each exam takes up to 4 hours and that does not include nursing documentation, coordination of services, referrals, follow up exams, testifying in court as needed, and release of records to law enforcement and Office of Children's Services and other agencies involved," Enersen wrote.

The Soldotna program has had as many as six nurses, enough to handle the load, James said. Three is too few.

The work is draining -- and rewarding, the nurses said.

With child victims, many cases involve physical abuse and neglect, Enersen said in an interview. "We'll see skull fractures, rib fractures on babies. We'll see abrasions and bruising. Head trauma. Shaken babies."

"We've certainly had people with severe head injuries and people who have been strangled and people with broken bones and people that have been run over with cars," James said. "Hit by pipes, by baseball bats. Shot at, stabbed. Kids starved and kids battered and assaulted and sexually assaulted.

"I can hardly think of what we haven't seen."

Many people assume that forensic exams, especially of sexual assault victims, are a second form of trauma. Enersen doesn't see it that way. "We can help normalize their body. Your body is OK. You are going to be OK."

James said the Soldotna program is changing from one with nurses on-call to one in which they'll work a set schedule so they can "rejuvenate and not burn out."

"It's really hard going to bed at night and not knowing if you're going to be called in in 20 minutes or three hours," she said.

In Anchorage, Providence Alaska Medical Center was down to eight forensic nurses, half of what the organization needs to be fully staffed, when the hospital decided to shut down the service overnight starting Oct. 1. The hospital will resume round-the-clock services Nov. 16 by shifting two nurses from their regular duties to work full time on sexual assault exams. Most of the Providence nurses work on-call, and the program's manager was covering many shifts herself.

Multidisciplinary teams that respond to sexual assaults also operate in Dillingham, Bethel and Fairbanks, state officials have said. The Mat-Su, Juneau and Cordova have been trying to form their own teams.